INTRODUCTION: Measuring Quality of Life (QOL) has become a vital part of assessing effects of migraine treatment in many international studies. However, only recently have measures assessing patients’ perceptions of and satisfaction with migraine treatment been available and none with linguistically validated translations. Prior to use in an international trial, the PPMQ (developed in US English) underwent linguistic validation in 16 languages. METHODS: A QOL specialist coordinated the translation process of the PPMQ in each target country using the following methodology: 1) two forward translations by professional, native speaking translators of the target language who were fluent in English; 2) comparison and reconciliation of the translations by a QOL specialist and translators; 3) backward translation by a native English speaker; 4) comparison of the source and backward version; 5) review of the translation by a clinician in each country; 6) international harmonization. RESULTS: Linguistic, conceptual and cultural issues emerged when translating idiomatic phrases and response scales. "How consistently the medication prevented pain from coming back" had to be expressed through "reliably" or "constantly". Cultures less used to completing questionnaires had difficulty understanding instructions inviting respondents to express satisfaction with medication in relation to subsequent statements, therefore appropriate clarifications had to be added. The response scale "very completely, completely, average, incompletely, very incompletely" was impossible to translate literally. The following equidistant responses were substituted: "completely, quite a bit, average, a little bit, not at all". CONCLUSIONS: A rigorous translation methodology was performed to ensure conceptual equivalence and acceptability of translations. International feedback obtained through the translation process revealed issues regarding the original instrument, indicating that future amendments to the original may be necessary. Psychometric testing will be conducted to ensure reliability and validity of each translation, appropriateness of the questionnaire in each country, and comparability of data across countries.